Reducing Epileptic Seizures Through Operant Conditioning of Central Nervous System Activity: Procedural Variables

Cott, Arthur; Pavloski, Raymond; Black, A. H.

doi:10.1126/science.758682

Cited by 29 publications

(7 citation statements)

References 9 publications

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“…For instance, Cott, Pavloski, and Black (1979) reported that 3 months of SMR training was associated with significantly reduced seizure incident in five out of seven patients who had previously suffered from very poorly controlled seizures. These high success rates of SMR training were further confirmed in investigations that employed more elaborate control conditions, such as non-contingent, or random feedback (Finley, Smith, & Etherton, 1975;Kuhlman & Allison, 1978;Quy, Forrest, & Hutt, 1979;Wyler, Robbins, & Dodrill, 1976).…”

Section: Clinical Findings With Epilepsymentioning

confidence: 98%

Foundation and Practice of Neurofeedback for the Treatment of Epilepsy

Sterman

Egner

2006

Appl Psychophysiol Biofeedback

265

170

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This review provides an updated overview of the neurophysiological rationale, basic and clinical research literature, and current methods of practice pertaining to clinical neurofeedback. It is based on documented findings, rational theory, and the research and clinical experience of the authors. While considering general issues of physiology, learning principles, and methodology, it focuses on the treatment of epilepsy with sensorimotor rhythm (SMR) training, arguably the best established clinical application of EEG operant conditioning. The basic research literature provides ample data to support a very detailed model of the neural generation of SMR, as well as the most likely candidate mechanism underlying its efficacy in clinical treatment. Further, while more controlled clinical trials would be desirable, a respectable literature supports the clinical utility of this alternative treatment for epilepsy. However, the skilled practice of clinical neurofeedback requires a solid understanding of the neurophysiology underlying EEG oscillation, operant learning principles and mechanisms, as well as an in-depth appreciation of the ins and outs of the various hardware/software equipment options open to the practitioner. It is suggested that the best clinical practice includes the systematic mapping of quantitative multi-electrode EEG measures against a normative database before and after treatment to guide the choice of treatment strategy and document progress towards EEG normalization. We conclude that the research literature reviewed in this article justifies the assertion that neurofeedback treatment of epilepsy/seizure disorders constitutes a well-founded and viable alternative to anticonvulsant pharmacotherapy.

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Section: Clinical Findings With Epilepsymentioning

confidence: 98%

Foundation and Practice of Neurofeedback for the Treatment of Epilepsy

Sterman

Egner

2006

Appl Psychophysiol Biofeedback

265

170

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“…Cott et al 11 studied 3 mentally disabled individuals with seizure disorders and provided them with 8–12 Hz occipital EEG biofeedback training. All 3 participants experienced decreases in some of their seizure activity; however, their inability to increase 8–12 Hz activity brought into question the effectiveness of feedback stimuli used as reinforcers with these individuals.…”

Section: Appendix: Review Of Literaturementioning

confidence: 99%

“…The results of the study indicate that changes in procedures will be necessary for future studies to determine if 8–12 Hz occipital EEG training is effective in reducing epileptic seizures. 11…”

Section: Appendix: Review Of Literaturementioning

confidence: 99%

“…Research in the United States has emphasized sensorimotor rhythm (SMR) up-training (i.e., increasing 12–15 Hz activity at motor strip) 8 –10 with or without simultaneous down-training of slow rhythms (e.g., decreasing 4–7 Hz activity). 11 –14 Research in Europe, on the other hand, has focused principally on slow cortical potentials (SCP), which last several hundred milliseconds and reflect the level of excitability of underlying cortex. Negative SCP-shifts are observed before and during seizures and positive shifts appear after their abatement.…”

Section: Introductionmentioning

confidence: 99%

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Meta-Analysis of EEG Biofeedback in Treating Epilepsy

et al. 2009

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About one third of patients with epilepsy do not benefit from medical treatment. For these patients electroencephalographic (EEG) biofeedback is a viable alternative. EEG biofeedback, or neurofeedback, normalizes or enhances EEG activity by means of operant conditioning. While dozens of scientific reports have been published on neurofeedback for seizure disorder, most have been case series with too few subjects to establish efficacy. The purpose of this paper is to meta-analyze existing research on neurofeedback and epilepsy. We analyzed every EEG biofeedback study indexed in MedLine, PsychInfo, and PsychLit databases between 1970 and 2005 on epilepsy that provided seizure frequency change in response to feedback. Sixty-three studies have been published, 10 of which provided enough outcome information to be included in a meta-analysis. All studies consisted of patients whose seizures were not controlled by medical therapies, which is a very important factor to keep in mind when interpreting the results. Nine of 10 studies reinforced sensorimotor rhythms (SMR) while 1 study trained slow cortical potentials (SCP). All studies reported an overall mean decreased seizure incidence following treatment and 64 out of 87 patients (74%) reported fewer weekly seizures in response to EEG biofeedback. Treatment effect was mean log (post/pre) where pre and post represent number of seizures per week prior to treatment and at final evaluation, respectively. Due to prevalence of small groups, Hedges's g was computed for effect size. As sample heterogeneity was possible (Q test, p=.18), random effects were assumed and the effect of intervention was -0.233, SE = 0.057, z = -4.11, p<.001. Based on this meta-analysis, EEG operant conditioning was found to produce a significant reduction on seizure frequency. This finding is especially noteworthy given the patient group, individuals who had been unable to control their seizures with medical treatment.

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“…A more recent meta-analysis with strict inclusion criteria reviewed 10 studies from 1970 through 2005, each providing detailed information on patient selection, utilizing SMR-or SCP-based biofeedback, and reporting individual subjects' pre-and post-treatment seizure data [54]. Nine studies were of SMR in participants with refractory epilepsy, with withinsubject designs [55][56][57][58][59][60][61][62][63], while one study utilized SCP-based biofeedback [51]. All studies reported an overall mean decrease in seizure frequency following treatment, and 74% of all participants reported fewer weekly seizures in response to EEG biofeedback.…”

Section: Biofeedbackmentioning

confidence: 99%

Cognitive and Behavioral Interventions in Epilepsy

Leeman-Markowski

Schachter

2017

Curr Neurol Neurosci Rep

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Encouraging results have been found for the cognitive behavioral therapy-based Reiter/Andrews approach and mindfulness or arousal-based programs (e.g., yoga, meditation, relaxation, and biofeedback). Most studies attained responder rates between 45 and 90%. Cognitive and behavioral interventions may be considered as low-risk adjuncts to standard therapies. Efficacy data are limited, however, by small numbers of subjects, inadequate randomization, controls, and blinding, brief trial durations, varying methodologies, and variability in the presentation of results. Additional clinical trials are warranted.

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Reducing Epileptic Seizures Through Operant Conditioning of Central Nervous System Activity: Procedural Variables

Cited by 29 publications

References 9 publications

Foundation and Practice of Neurofeedback for the Treatment of Epilepsy

Foundation and Practice of Neurofeedback for the Treatment of Epilepsy

Meta-Analysis of EEG Biofeedback in Treating Epilepsy

Cognitive and Behavioral Interventions in Epilepsy

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